Hypertension is a major risk factor for ischemic heart disease and stroke, which are leading causes of morbidity and death worldwide. Besides the contributions from genes and adult life-style, this review highlights that adult hypertension is likely to be a legacy of preterm birth. This knowledge has important health implications for the new and rapidly growing population of young people born very preterm. Increased awareness among both families and professionals about preterm birth being a perinatal risk factor for adult hypertension is needed. Measurement of blood pressure in children and young people born preterm is also recommended, all to detect and treat hypertension in young people born preterm long before end organ damage occurs.